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[Interferences between angiotensin-converting enzyme inhibitors and spinal anesthesia]
1Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris.
Cahiers D'Anesthesiologie
|January 1, 1994
Summary
Discontinuation of angiotensin-converting enzyme inhibitors (ACEI) before surgery does not increase hypertensive episodes. However, continuing ACEI therapy may lead to exaggerated hypotension during anesthesia induction.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Context:
- Essential hypertension management often involves angiotensin-converting enzyme inhibitors (ACEI).
- Surgical patients on ACEI therapy require careful consideration regarding perioperative medication management.
- Standard practice for other antihypertensives involves continuation up to surgery.
Purpose:
- To evaluate the necessity of stopping ACEI therapy before surgical procedures.
- To determine if ACEI withdrawal prevents perioperative hypertensive episodes.
- To assess the risk of hypotension during anesthesia induction when ACEI therapy is continued.
Summary:
- Literature review indicates that stopping ACEI therapy before surgery does not increase the incidence of hypertensive episodes.
- Continuing ACEI therapy is associated with an increased need for vasopressors (e.g., ephedrine) to maintain blood pressure during anesthesia induction.
- ACEI therapy may exacerbate hypotension during anesthesia by affecting vascular tone and autonomic regulation.
Impact:
- Findings suggest that ACEI withdrawal is not necessary to prevent perioperative hypertension.
- Anesthesiologists should be aware of the potential for exaggerated hypotension in patients on ACEI therapy.
- This information aids in optimizing perioperative management strategies for hypertensive patients undergoing surgery.